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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2008 -00313 COMMUNITY DEVELOPMENT DATE ISSUED: 6/5/2008 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 25111 CC - 09601 SITE ADDRESS: 15740 SW GREENS WAY ZONING: R -12 SUBDIVISION: SUMMERFIELD NO.2 LOT : 123 JURISDICTION: TIG PROJECT: LEIPZIG Project Description: Installing (1) branch circuit for ground water service. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st WIO SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: JOE LEIPZIG ATLAS ELECTRICAL CONTRACTORS 15740 SW GREENS WAY 4403 SE ROETHE RD TIGARD, OR 97224 MILWAUKIE, OR 97267 Phone: 503 - 670 -4999 Contact #: FAX 503 - 659 -4944 PRI 503- 659 -2212 FEES Description Date Amount Reg #: ELE 3 -2C [ELPRMT] ELC Permit 6/5/2008 $46.85 LIC 1532 [TAX] 12% State Surchar 6/5/2008 $5.62 SUP 5009S Total $52.47 REQUIRED ITEMS AND REPORTS This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throu h OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. Issued By `1 Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. ATLAS ELECTRICAL Fax:5036594944 Jun 3 2008 15:35 P.02 7 l est lrical Per App lication . FOR DEFY E USE °NIA" 2` I .' r City of Tigard - - aiti ed 13125 SW Hall Plvd., Tigard, OR 97223 RECEW .; • 1 I� - t No.: V'Gc a r e 3 • Phone: 503.639.4171 Fax: 503.598.1960 D a teB --t : w Other Permit &• �., T i G A R Tt Inspection Line: 503.639.4175 Date ReadyBy. Internet: www.ttgard-or.gov JUN 0 3 200 i A See Pest z for S Not ed/Me thod + i�f3i t t t ire fttl s. 1+ �r trr 1 Al... Supplemental Information 1 ° " :1!S°,: +11 V ,�;v� �°'iffffliA,^t'"`,ileMi�df`FM "l�111I11 ,P7 .. �1� '' '''' i ' i I rxf Jf ''2 4I N ' a, a'4 tot 'l...r,.l } r4 4 i� {1,, . Yr i 1. i ,"t e ta_ •, r r r ❑ New construction y a 'l. ! :f ed `:j • ) ) lll'r ® Addition/alt � 1:0116. , a Please check ail that apply (submit 2 sets Of plans wlikms checked below); `! ❑ Demolition ❑ Other DIVISION ❑ Service or feed 400 am p s or snore ©Buildin s over - „ :.: o three stories. : I;g..S ), y ii5r' s : }, 5: ;.1.1 1�llll 1 9 I i w e , where the available fault current ❑ Marinas and boa tyards. i t+1, t' f lt' I t t`C f ^ .. ,I.. u r g exceeds lo,000 +I - 1 -- `?pit E' . , � - . 11 G 4,iI�'4 i l�.+� �meo,�.l�ta�: - F , s ;1 { i ,t ?�bE �'. iif�5il amps at 150 v olb or ❑ floating buildings. ® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building less to mend, all other or exceeds 14,00o El commercial -use agricultural 0 Multi-family ❑ Master builder amps pu mp all ogler installations, buildings. � i } ft p �'i . l �. ❑ Other: El pum. ❑ Tnsrallatiou of 75 KVA or , �I : � HE� ,:€ re•`�g9,`� P 1 G 1 "17��y�c-'�j'f11 m�ro� � 1 r�,�� E '`. '1 i � '1 .. - tdtEZti`^�irsz'1a,1lt�r i }plt, enc 5 larger lt. It s E eta laH t .-..1tn s t ..ac? IS Q i , 1 13 ❑ k Y Y:r: s deri sysfran Ullil' }:�gl, ❑ Addirioo of new norm load of [] `•p^ ..b., =.1.2,• .. 3„ Job no.: 17609 Job site address: 15740 SW Greens Way loom' or more. occupancy, ❑ Six or more residential units. ❑ Rocreanional vetiiclo pack;. City /State/ZIP: Tigard, Oregon 97224 ❑ Health -care facilities. El Supply voltage for more than Suite/bld /a t. no.: o Hazardous locations- 600 volts nominal. p Proj Project name: Bob Leipzig ❑ Service or feeder 600 amps or more. Cross street/directions eet/directi VIRUS I r' r "`T° one to job site: '' !!„„ l " . ; r $$ - q�^ 1ti�1 I , "�t.�'�:F�n"t[�n.� nB� � �h'1 � y ,�_ ; } � l '.�� ! fl� { {. nwri.tion IMO, Fee Total • - New residential single- or multi- family dwelling unit _ Includes attached garage. Subdivision: I Lot no.: 1,000 sq. ft or less 145. 4 Tax map /parcel no.: Ea. add') 500 sq. ft or portion 33. 1 `" it ?t '' �,' lc a t, y �� aamr s t s: �nu ff,lI¢¢ Limited energy, residential f I 4 tr d]< 1 i";dk`a to 1l 2 U]' �,Sa15^'I 1 1 i M I} lV T �isir�^ t�ttl�sa�t3dl ,'�;«�3�� .?�li�(�tl'F,��2 � (with above eq. R) 75.00 2 Ground water service. Limited energy, multi - fam residential (with above sq. ft 75.00. 2 Services or feeders installation, alteration, and/or relocation iS r11gP: s. ° 0r , ., , , . fl ! 1 z1, aq r )�' I.,; # r 'I 201 amps to 400 amps 200 amps or less =Il afi'i i1. t +sy I iE< �u51ii e II ` {,1 � E 1 ... S 80 - 2 Natne- 106 85 2 401 strips to 600 amps 1 60.60 2 Address: 601 amps to 1,000 amps 240.60 2 Over 1,000 amps or volts 454.65. 2 City/State/ZIP. Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fa ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Owner Signature: PP j 66 Date: Branch circuits - new alteration, or extension, per , anel r ° � 1 1 ?47t'1 { ° 'iE:I a�tif+{ k' 11tg fs A. Pee for branch circuits with ' l�: 1 rT ai'' ,Alt , _ e , lki above service or feeder fee, Business name: each bu n circuit 6.65 2 B. kee for bran ch circuits Contact name: • • without service or feeder fee, 1 46.85 46.85 first branch circuit 2 Address: Each add'. branch circuit 6.65 2 City/State/ZIP: Miscellaneous (service or feeder not included) Each manufactured or modular 90.90 Phone: ( ) Fax: : ( dwelling, service and/or feeder 2 Reconnect only 66-85 2 E -mail: :.I' Vr'15, �9i 7 u r lac 4 " y, 11� _Pump or irrigation circle 53.40 2 '' il lixk»gill�.l .:' = �1 , tau i ,!' : 4 1 I t �t k011 Ti i'x t 441 1 " t Illit l a ° Si or r oune lighting .;��f�� ai, �5:1..>�,flll a, � .sl —2222 �$� � g 53.40 2 Business name: .Atlas Electrical Contractors, Inc. Signal circuits) or limited - energy panel, alteration, or Address: 4403 SE Roethe Road extension. Describe: Page 2 2 City /State/ZIP: Oregon 97267 Each additional inspection over allowable in any ; oftbe above Phone: (503) 659 -2212 Fax: (503) 6594944 Per inspection 62.50 Investigation per hour (1 hr mirk) 62.50 CCB Lic.: 1532 Electrical Lic.: 3 -2C Suprv. Lic.: 5009S J{ In r dustrial plant per hour 73.75 l loll 111 IMIZ�.' "E'� � i .� a�,=s '§ a't"" . /1 °� 1°1 ,'. :•: . Suprv. Electrician signature, required: �tc d ill!},;: -i. LL - +� Subtotal: 46.85 Print name: Ty Shepersky 7i ate: 6/3/08 Plan review (25% of permit fee): State surcharge (12a / ofpemvt fee): 5.62 Authorized signature: .4.4.1,.......„,,,!, TOTAL PERMIT FEE: 5147 Print name: Ty Shepersky / Date: 6/3/08 This permit application expires if a permit is not Obtained with/nisi) days after it has been accepted a complete. 1: 1Bw7diasiPeraur ~tnCGperm 05,23 /os - Number of inspections allowed per permit " 440- 4615T111/05/tOM/1M.